Provider Demographics
NPI:1346680667
Name:THOMAS, TAMMIE RENEE
Entity Type:Individual
Prefix:
First Name:TAMMIE
Middle Name:RENEE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAMMIE
Other - Middle Name:RENEE
Other - Last Name:GLASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:828 JEROME LN
Mailing Address - Street 2:
Mailing Address - City:CAHOKIA
Mailing Address - State:IL
Mailing Address - Zip Code:62206-2028
Mailing Address - Country:US
Mailing Address - Phone:618-339-4098
Mailing Address - Fax:618-337-3767
Practice Address - Street 1:828 JEROME LN
Practice Address - Street 2:
Practice Address - City:CAHOKIA
Practice Address - State:IL
Practice Address - Zip Code:62206-2028
Practice Address - Country:US
Practice Address - Phone:618-339-4098
Practice Address - Fax:618-337-3767
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist